8 The ABCs of Proprioception

proprioception: the body’s ability to transmit afferent information regarding position sense, to interpret the information, and to respond consciously or unconsciously to stimulation through appropriate execution of posture and movement

Basic Concepts of Proprioception Targeted after flexibility, strength, and endurance have improved Involves agility, balance, and coordination

Components of Proprioception

proprioceptors: afferent nerves that receive and send impulses from stimuli within skin, muscle, joints, and tendons to the central nervous system An individual’s balance, agility, and coordination are determined by the reception, interpretation, and response that are initiated by proprioceptors.

Proprioceptive Receptors Cutaneous receptors Fast-adapting- responsible for vibration senses Slow-adapting I and II-sensory perception such as skin stretching Muscle and tendon receptors Muscle spindles GTOs (continued)

Proprioceptive Receptors Joint receptors Ligament receptors Collaboration of afferent receptors

Central Nervous System Proprioceptor Sites Spinal cord Brain stem Cerebral cortex

balance: the body’s ability to maintain an equilibrium by controlling the body’s center of gravity over its base of support

Balance Necessary for static and dynamic activities Influenced by strength and by sensory input from CNS Sensory input Vestibular system Oculomotor system Proprioceptor system Balance tests: Romberg, stork stand

Feedback System for Coordination

coordination: the complex process by which a smooth pattern of activity is produced through a combination of muscles acting together with appropriate intensity and timing

Coordination Accomplished through a complex neural network Some muscles stimulated and others inhibited Timing and intensity of muscle response are key Strength and proper neural system function are necessary for coordination

Components of Coordination Activity perception Feedback Repetition Inhibition

Progression of Coordination Development Start with static, simple exercises. Progress to dynamic, more complex exercises. Accuracy of performance is vital in exercise execution. Stop when fatigue, lack of coordination begin to appear.

agility: the ability to control the direction of a body or its parts during rapid movement

Agility Requires flexibility, strength, power, speed, balance, and coordination Involves rapid change of direction and sudden stopping and starting Progression of therapeutic exercise for agility Activities should resemble the patient’s sport activities

Therapeutic Exercise for Proprioception Balance first, then coordination, then agility Simple to complex Initial exercises performed slowly, in controlled situations Advancement made only after the activity is mastered Progression: to more complex, sport-like activities Goal: to perform accurately

Lower-Extremity Progression Stork stands: with eyes open, closed; on unstable surfaces; with distracting upper-extremity activity Dynamic activities: lateral, then change of direction; combined balance, coordination, agility; distracting upper-extremity activities Plyometrics Sport-specific activities

Upper-Extremity Progression Passive and active joint repositioning PNF rhythmic stabilization Closed kinetic chain stabilization Straight-plane and multiplane upper-extremity movements Rubber tubing activities Plyometrics Sport-specific activities